Provider Demographics
NPI:1578846143
Name:POINDEXTER, MARY DENISE (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DENISE
Last Name:POINDEXTER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:DENISE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2290 NICHOLASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2418
Mailing Address - Country:US
Mailing Address - Phone:859-276-1553
Mailing Address - Fax:859-277-8380
Practice Address - Street 1:2290 NICHOLASVILLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2418
Practice Address - Country:US
Practice Address - Phone:859-276-1553
Practice Address - Fax:859-277-8380
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist